You tried 1+ mental health medications before you found one that worked.
June 23, 2019 10:45 PM   Subscribe

YANMD. You at some point have taken a mental health medication prescribed by a licensed medical professional. During the first go round(s) of being on medications, it was a trial and error process. At some point, someone (you? your dr?) noticed something was off, and said "let's stop this med, and try something else". Something (dose/class/scrip?) was adjusted, and you started the trial and error process again. (Repeat?) Now, you are better medicated. You trust your medication and continue it as long as needed, because you no longer suffer the way you used to. How did you mentally navigate this trial and error period(s)?


I'm not particularly picky about what your or my actual condition is diagnosed as (ex. splitting hairs about depression vs. anxiety vs. PTSD, or about situational vs. chronic version of it). I care slightly more, but am not putting too much stock in knowing about exactly which drug or class (MAOI, SSRI, other) it was you took at what point. I am instead mostly interested in how you navigated the unknown of trying (and possibly failing with) your first (and or second and or third etc.) mental health medication trial runs.

I personally am asking this question from basis that I just have run out of other feasible options to try that aren't pharmaceutical medication, for what I can only think to call extreme, worsening, persistent despair about the world and my worth inside of it - I don't have any trust left for others (that ran out a while ago) and have recently lost any seeming stable sense of trust in even myself (or maybe it's the reverse? I trust nothing right now). My most recent diagnosis is PTSD, and I've had generalized anxiety, social anxiety, and depression thrown around in my medical file at different points in the last few years. I have never, until recently reaching what I hope is rock bottom, seriously considered mental health medication as a possibility for myself.

I am terrified of the idea of diving into the unknown of brain chemistry changes. I need to narrow down how to approach the wait and see, trial and error period of being medicated -- without putting myself in more dire straits than I'm already in. An example of 'more dire straits' would be if a medication's side effect (increase in suicidal thoughts, or uncontrollable outbursts of anger, or significant weight gain that further distorts body image issues) is even worse than the current state of despair. (Again, I'm not that fussed about diagnoses and very fussed about specific medication related results).

I have gleaned a ton of extremely helpful advice about mental health meds lately from doing a deep dive into previouslies, as I struggle and flail through these dark days. These examples in particular (one and two and three and four and five and six and seven and eight) for related topics.

Despite a chorus of anecdata gently nudging me to at least try something other than ignoring my problems or positive thinking my way to well being, I am still terrified of taking medication. And as far back as I dug in the archives, I didn’t quite see a question that focused on the topic of identifying what medication side effects could be bad enough to really warrant changing course (vs. sticking with a medication a while longer, to see if it evens out and helps more over time). My real fear is just blindly trusting your medical team taking a stab in the dark, with your brain being the guinea pig for godawful side effects that are worse than no medication at all.

Archivally and personally speaking, my little tiny silver lining dream with this post is the hope that one day I’ll be able to see mental health medication related questions (of any particular diagnosis/class/etc.) and chime in (as appropriate) with my own personal linked comment back to this post saying “hey! here’s proof that once, I was where you are now. [time period] later, I am doing so much better. maybe what you read about my experience will help you too”. One of the things keeping me going right now is the idea that my current distress might be worthwhile sometime down the road - not just to me and my life, but in my ability to help other people in distress too.

Please do let me know if any of these spark something from your own life experience:

1. If you were already in pretty bad shape [mentally/self-esteem wise/trusting in your own experience and validity] before trying medication - how did you have any idea how to trust whether your first few medication trial runs were helping or hurting?

2. Have you ever gone from bad to worse, suicidally speaking, because of a bad fit mental health medication? How did you survive this and stay motivated to keep trying new meds despite it?

3. Did you have side effects that worsened your personal or professional reputation (such as angry outbursts, lethargy, paranoia, zoning out, forgetfulness, other), that you wished you had caught sooner? How did you catch on to these negative changes in yourself?

4. What exact symptoms did you experience during the “incorrect med/dosage/class” phase that you had a hunch or were sure that it was wrong for you? How long did it take to know it?

5. How often were you in touch with your licensed medical professional during the trial and error process?

6. How active or passive were you in the process of selecting the new, better medication with your licensed medical professional?

7. Did you end up on an entirely different type/class of drug than the one you started on? Does that type of drug not even necessarily fit what is normally prescribed for your “official” diagnosis?

8. What resources/tools/exercises did you use to help you trust yourself in your experience of your not quite right reaction to the medication?

9. How much contact did you have checking in with people who know you well either using some sort of objective criteria or just their opinion, to help you decide on whether your side effects were bad enough to consider switching?

10. Did you taper off of one and then taper onto another? Or cross taper?

11. Did you have to advocate to be seen by someone more specialized at any point in the process (to help deal with things like cross-tapering maybe), and how did this go? (ex. you were first given a trial run drug scrip by your primary doctor but at some point had to switch to a psychiatrist)?

12. What advice do you have for past you, during that trial and error time?

ALTERNATE QUESTION - One acceptable de-rail would be from people who have experienced minor to moderate (whatever that means to you) side effects on one medication, that were absolutely so worth the improvement of your overall outlook on life, that you never wanted to bother monkeying around further (and so you remained on this medication as long as needed, side effects and all.) If this is you, please be very specific if possible with time frame and symptoms and your decision making process.

Please please do not recommend or contribute:
1. That I stay away from pharmaceutical medication altogether, or that I try 1+ medication and if I don’t like it or it doesn’t work, just taper off it and go off meds forever. I want to hear from those of you who did find your right fit (either short or long term) so that life is OK now.
2. Any medicine you take against the advice of, or without knowledge by, your licensed medical professional
3. Anything that is over the counter, federally illegal, semi-legal or otherwise obtained outside of a prescription by a licensed medical professional (USA, if relevant)
4. General life advice, general well being tips, or another well-meaning f*(#*(%ing suggestion to make sure I exercise and sleep soundly and hydrate.
posted by seemoorglass to Health & Fitness (28 answers total) 5 users marked this as a favorite
It is totally and entirely possible that you will get what you need from MeFi, and I definitely don't want to dissuade you from finding your people here, but if you don't get quite the answers you are seeking, or if having some company and a sense of community will be of help, or if you just feel hell of meds frustration and want to hang out and vent with people feeling the same way, you may want to check out Crazyboards, if you haven't already, because this is 1000% their bailiwick.
posted by halation at 11:20 PM on June 23, 2019 [5 favorites]

(I also liked crazymeds when I was thinking of going on medication.) I have switched twice. I started on Celexa, which is very common. My doctor asked me to call her in about three weeks. I did and asked to switch: the insomnia was like nothing I had ever experienced. It was an easy call. I went to Lexapro, which is very similar to Celexa- it’s just one of the two molecules. That worked well. I stayed on it for over a year. And I took a lot of naps. And eventually my child said, you’re napping again. The disappointment was so clear. And what’s the point of being mentally healthier if you can’t be there for your loved ones? Nonetheless I would not have switched if I did not have a child. So I went and met my doctor again and we talked much longer, and went with Prozac. It does not work as well, but I am less sleepy. All of the medicines are in the same class. I did not cross taper, I just switched, and I did not get serotonin syndrome. (YMMV.). Good luck to you.
posted by kerf at 11:46 PM on June 23, 2019 [1 favorite]

I've had minor mental health issues, and take care of someone who has serious mental issues. We both have been prescribed various medications, been titrated up, down, or off, and have found medications that have worked for each of us to varying degrees. There is no cookie-cutter answer I have as to how I dealt with these changes, except patience, which can be awfully difficult when your system is not behaving neurotypically.

As you have probably been told or learned, each brain is a unique biochemical entity: different meds work or don't work for different people; the prescribing docs—even the most learned, empathetic, or indefatigable docs are unsure about the mechanisms behind why psychiatric meds do or don't work—but they have a large arsenal of meds to try, and data on them. So my only word of advice on how to deal with all this on the "consumer" end of things is: patience. Some drug or therapy is bound to help, eventually.

My only SOLID recommendation that falls under some of your criteria is that you connect with your local chapter of NAMI, the National Alliance on Mental Illness. It's a trove of psycho-educational resources—opportunities etc. to connect with support groups, networks and others with shared experiences. (NAMI's well-represented in the Boston Metro area, too.)

(Also, call McLean Hospital and root around asking about their on-campus support groups on their campus in Belmont, if you aren't too far away; they have some amazing support groups for all kinds and levels of mental health issues. The Cole Resource Center is also located on their campus, although independent from McLean itself. They're free and intelligent; support group moderators there have been empathetic, experienced, and wise for the most part.)
posted by not_on_display at 12:02 AM on June 24, 2019 [5 favorites]

The first psych med I tried was Prozac, and I was super nauseous all the time. I was told that people's reactions to SSRIs can change a bunch in the first 4-8 weeks, so I took it for six weeks and stopped. I could tell it wasn't worth it because I'd lost a concerning amount of weight, was basically only eating saltines and pasta with butter, and felt generally terrible.

The second med I tried was Celexa, which was too sedating and worsened undiagnosed ADD, so less unambiguously bad, but...not great.

I have been on Wellbutrin for most of the past six years. It doesn't always seem like it's doing a lot, but the depression that happens on it is much less brutal than the depression that happens off it. Too little Wellbutrin and I'm emotionally kind of volatile / despairing and exhausted in the evening, too much and I can't sleep.

A whole bunch of dicking around with psych meds, including these and including ones I started after Wellbutrin, has had negative professional/personal effects. In hindsight, though, they weren't as bad as the unmedicated brain problems, shrug emoji.

I have mostly had spotty access to psych care and only been able to see my prescriber every few months, or less often, which makes straightening out dosages and drug types super hard. It will probably be expensive to find someone who answers emails and is able to see you more often, but if you can pull it off, it's great.

If you can find a psychiatrist willing to let you sign a very serious notification of privacy whatevers that says you know emails are totally insecure and you want your health information discussed in emails anyway, dooo it. This may be US specific, also I don't recall the official term for these things.

I heard on social media that there's genetic tests for SSRI non-response you can take, and some people's insurance pays for them, which I'd look into if I were starting out now.
posted by bagel at 12:16 AM on June 24, 2019 [1 favorite]

I've been on 7 (or maybe 8?) different medications for depression/anxiety and I think I'm doing pretty well now so I'll just answer your questions directly. I've had a pretty wide variety of side effects, none of them were unmanageable but several were not worth the benefits.

1: To tell if it was working or not, I focused on specific symptoms. "Did the medication cure my depression?" is a really hard question to try and answer when you're depressed, but "has the medication made it easier to get out of bed" or "was it easier for me to talk to other people" were much easier for me to answer.

2: 2 of the medications I tried increased my tendency to obsess about suicide. I never made any plans, but they would make me think about suicide at completely random times. In one case it was pretty sudden so I called my psychiatrist and we stopped the medication. In the other case it was more subtle so I didn't realize the medication was doing it until I switched to a new one. In both cases I was able to work through it because I recognized the thoughts as compulsive thoughts that I did not need to act on. Suicidal thoughts are extremely unpleasant and emotionally draining but if you understand what's going on they can be dealt with.

3: Honestly, none of the medications I tried hurt my career or reputation. Several of them did make interpersonal relationships more difficult, mostly due to sexual side effects and anhedonia

4: My worst side effect has always been anhedonia/emotional numbness. Usually when I am on a new medication it's fine, but after a few months if my dosage is too high I will start to lose touch with my emotions and become very detached. I did not realize this was happening the first few times because it's pretty subtle, now I can tell when it's happening and pull back on my dosage

5: When I started a new medication I would usually see a psychiatrist after 4 weeks as you can't really tell it's working before that. I also have a therapist I've been seeing every 2 weeks for years

6: I have been very active in choosing what medications to try and 75% of the time I picked the next medication. I always got really nervous about making a suggestion but my psychiatrists have been very receptive

7: Not really, I started on prozac and ended on wellbutrin which are both mainstream anti-depressants. I tried some weirder things in the middle that didn't work at all

8: Writing has been my most useful tool for dealing with medication changes. Journals are great because you can read what you wrote a month ago and compare it to what you write now, and you can actually see the differences

9: I told my therapist and my mom about my medication changes and asked them to watch out for anything dramatic. They never really noticed anything other than my general mood changes.

10: When changing drugs I follow my psychiatrist's advice because it's different for each drug combination. Once I'm on a drug, I have tapered up and down myself on several occasions to try and find the right mix, after I find it I talk with the psychiatrist and make that dosage official

11: When Prozac originally stopped working for me, I went to my general practitioner first and they were honestly pretty useless. I then went out and got a psychiatrist to help me try new drugs

12: I wasted around 6 months when I pushed my psychiatrist to go back to Prozac after trying a different drug that wasn't working. The Prozac didn't work any better the second time, and there's really no reason why it would have.
posted by JZig at 12:43 AM on June 24, 2019 [2 favorites]

My TLDR is that in most cases side effects are going to be really irritating and potentially damaging, but you don't have a reason to panic. As long as you know what's going on and blame the drugs instead of yourself, you'll be able to deal with them in the short term. In the long term, you'll have to decide if the positives are worth the negatives, and they often won't be. Good luck!
posted by JZig at 12:51 AM on June 24, 2019 [1 favorite]

First, my heart goes out to you. I know how hard this is, because I've been where you are. You're being *really* brave right now and a lot of the fear of meds is the anxiety and depression talking to you. They are nasty, lying fuckers.

I'm currently on both Wellbutrin XR and Effexor ER. I first tried Prozac, then I think Zoloft. A couple others I can't recall. The dosages were increased on them, they sort of worked - meaning that the fucking darkness wasn't so dark, I was able to get out of bed and perhaps take a shower. Yet it was still a big effort. Every change got a little better, but not *quite* (kind of like when your glasses script is wrong). The Wellbutrin - probably at least 12yrs now? - made a substantial difference after we played w the dose a few times - until it wasn't doing the trick as much. I was irritable, not sleeping, shouty and short with my family. I also didn't laugh anymore. I knew that the Wellbutrin was working, couldn't go higher on the dosage but didn't want to go through the whole rigamarole of switching meds again. Effexor is used as an adjunct to other SSRIs, so I talked to my doctor and he agreed to give it a shot. Thankfully it's helped. I'm thinking it's got to be maybe 8yrs I've been taking it at this point.

I have a cocktail of meds I take for other medical stuff, and there was about 10-12 days roughly four months ago where I somehow missed the Effexor. Holy shit, I really thought I was losing it; constantly crying, really unable to handle stress and freaking my kids out. I was scaring myself. It was only after realizing that I had somehow forgotten my Effexor, that it made me realize that I really am chemically dependent on these meds. If I'm being honest, I could probably use an increase on the Effexor, but that's another thread.

Now, some more food for thought, my 14-1/2yo daughter was diagnosed with Bi-Polar I with Psychotic Features and Borderline Personality Traits last Spring. This was after six months of being misdiagnosed with Chronic Severe Depression and Anxiety. She was put on med after med after med before finally having genetic testing done. It's a very simple buccal swab test that determines your chemical receptiveness to different meds (in this case, she was tested for different antidepressants, antipsychotics, benzos, etc.). It turns out that she doesn't possess the genetic ability to process SSRIs. So, we have to go with SNRIs and some atypicals.

With regard to your question about weight gain, there is a med that she takes, Invega, that is very similar to Risperdal. It makes her hungry all the time and she did gain a lot of weight. We tried other meds instead of the Invega, but she just didn't do well on them. After a very long discussion with her and her doctor, she felt that she'd rather be overweight, work on her food choices and be happy with the ability to have a personality than be on a med that made her feel dead inside. I think she made an excellent decision. I'm proud to say she's been working on it and she's lost about 30lbs so far on her own. She also just downloaded Couch to 5k. She's also on Lithium which unfortunately causes acne. Shitty for anybody but really shitty for a teenage girl. We are working on it with Retin-A, some other Rx meds and regular cleanings. She's really been a trooper and has been taking it in stride.

We finally do have a cocktail that works for her. It took a lot of trial and error - and a REALLY good doctor that knew his shit (she went to a residential program for five months after being discharged). We were able to titrate some meds down and get rid of a couple (the least amount of meds, the better) and get others as close to where we can so she feels herself. I think, more than anything, having someone that knows you and can judge how you are while you work on the meds is probably the most important thing you can do. Thankfully, my daughter doesn't remember the darkest park of her inpatient hospitalization (she was there for four months). Without having someone there able provide reference and a good history, the doctors wouldn't have known what was typical or atypical for her behavior or personality.

There was more than one occasion where they thought stuff was fine and it absolutely wasn't. If you have someone who is willing to be your advocate, by all means engage them. A very, very big help was having my daughter journal. It was an excellent reference point for mental clarity. Especially when some meds take a few weeks to kick in. Fortunately some of them now take significantly less time than they used to. I was able to sometimes see changes start as soon as 10 days versus 3-4 weeks.

The recommendation of McLean upthread is excellent. It's one of the places I tried to get her into. They are very kind and helpful. You may want to consider even a part time program, maybe nights or weekends. I'm sorry this got long; I wanted to give you an idea of all the trial and errors we've been through -- and HOW WORTH IT they've been.

If there is anything I can do, or anything I may be able to answer, feel free to MeMail me. There truly is light at the top of this deep hole. It will get bright enough to see the ladder out. I promise. My daughter finally came home the week before Memorial Day. We take it day by day, but she laughs and she smiles - and so do I.

Big, big hugs to you.
posted by dancinglamb at 1:22 AM on June 24, 2019 [4 favorites]

The one drug that made my daughter particularly suicidal was Abilify. She also ran into problems with the SSRIs, since she doesn't metabolize them. She had every side effect from them and non of the benefits. Because of this, SNRIs are the drug of choice, along with atypicals.
posted by dancinglamb at 1:29 AM on June 24, 2019 [1 favorite]

Gah. Final one. Every single drug I've been on or one my daughter has been on has been discussed in comparison to alternatives and I've been the one to choose it. The possible benefits, side effects, time it takes to kick in, dosage room - usually doctors tend to start conservatively and then move up. Never once was I "told" that I was being put on something and that was it. I'd personally get up and walk out if that was the case.

Regarding side effects, usually most are transient. Nausea, headache, dizziness, but they go away. A lot of them can be ameliorated by taking the med at night. The only time I ever had a problem was palpitations, but I have an arrhythmia, so that's me. A great resource for knowing when enough is enough is your pharmacist. Some psychiatrists are really great with this, others take a while to get back to you. Pharmacists can usually be reached all the time.

I checked in with my daughter's doctors daily, but with mine, it was maybe four weeks. I'm an RN, so I kind of knew if things weren't right.

I don't remember cross tapering. It depends how long you've been on something and what the dosage is - sometimes you can just stop a med if the dose is low enough. I wouldn't stop anything without your doctor knowing it, though.

I was never suicidal, but my daughter was. She would also increasingly self harm.
posted by dancinglamb at 1:43 AM on June 24, 2019 [1 favorite]

1) I didn't. I really didn't go the med route until I was hospitalized and it was explicitly clear that I had no other choices because it was pretty life or death at that point. The medication was miles better than my mental illnesses. Handsdown. Even with side effects and I wish I tried it sooner.

2) No medication was worse than what my brain was already doing to me. I did experience side effects with meds that were not going to work for me, that were severe, but the cool thing about medicine is you can just change them. Somethings didn't work there are other things to try, and we fiddled until something worked. So, I changed it. Changing my brain on my own did not work no matter how much I wanted it or tried. Medicine did work.

3) I've generally timed medication changes or adjustments over time off from work. The first few days are the most unpredictable and if never taken it before, so a long weekend or vacation was the most useful time to minimize impact . For me, my mental illness impacted work way more than the medicine ever did, but the way it impacted it was different so more noticable. Ultimately it didn't effect my work performance in any negative quantifiable way. I did become more sociable, and more on top of my work with time though.

4) The meds that super didn't work caused clear symptoms almost immediately . Mania, lack of sleep, rushed thoughts, I was too happy and it was not good. I had a med that caused me to have tremors so that was one was stopped. Everything else was just somewhere in the middle and I stuck with it for awhile. I relied on giving self report and the doctor deciding if it was with modifying or not.

5) when inpatient obviously I was in contact with someone all the time. On an outpatient basis it depends, but I have always been in contact with my therapist on an at least weekly basis and a psychiatrists at least monthly, but sometimes as frequently as weekly depending on the serverity and the extent it the change .

6) I was pretty passive unless I'd taken it before, then I was clear with opinions.


8)Therapy and family support

9)A little bit of both? Weight gain is a fraught topic for me, so that one was the toughest to deal with. I allowed for some gain, but ultimately there were meds I stopped because of it. Helpful meds, but I did find other things that worked.

10) Over the years I've done both, it depended on the needs in question. Ultimately in an outpatient basis all changes were super slow.

11) I've only used psychiatrists

12) Be patient and take gentle care.
posted by AlexiaSky at 2:26 AM on June 24, 2019 [1 favorite]

I looked at it as a numbers game, like dating. I started from the viewpoint that my doctor and I just had to get through the first X drugs in order to finally get to The One. I accepted that sub-optimal stuff would happen along the way, made a deal with myself not to kill myself for at least a year, and decided to interpret any side effects along the way as "interesting."

I also think it's worth noting that I thought your example one was pretty similar to where you are, and that same poster commented in another post six months later "I'm also on a SSRI, which I can 100% say has helped with my anxiety."
posted by DarlingBri at 3:08 AM on June 24, 2019 [2 favorites]

I tried a lot of meds and med combos, over at least ten years, before finding the one I'm on currently. This is unusual — most people find one much sooner, and my doctor seem to agree that I've had an unusually hard time. Think of this as a worst-case scenario.

The difference between "working" and "not working" wasn't entirely clear-cut. A lot of the "wrong" meds still helped some. In some cases I stuck with them for months or years, because they were better than nothing, and better than what I'd tried before. That better-than-nothing experience was one of the things that kept me trying — I'd had the experience of having my suicidal symptoms reduced by medication, so I knew it was possible, and when a doctor would say "Yes, and I'm confident a different medication could reduce them even more" I would be inclined to believe them.

The flip side of the bad stuff not being clear-cut is that the good stuff isn't either. When I was trying meds, there were definitely times when I felt utterly hopeless. My current meds still aren't perfect. I still have symptoms come back on bad days or bad weeks. Still, the meds I'm on now are much, much better than anything else I've tried — life-changingly better — and definitely worth the effort it took to find them.

I had one really awful experience where a med made me more suicidal. It also gave me a lot more energy, which I mistook for "helping," so I didn't get off it right away. Luckily, by then I'd also had not-perfect-but-good med experiences. I think, to be honest, if that awful experience had been my first one, I'd have given up. Other than that, the biggest thing that let me know a med wasn't working was "I still want to kill myself." But more generally, psychiatrists can give questionnaires that rank your depression on a numeric scale. The scale is based on a lot of symptoms, including suicidality but not limited to it. These questionnaires aren't perfect and don't catch everything, but if you go from a score of 40 to a score of 12, that's a pretty strong indication that something's up.

And honestly, the last thing that kept me trying new things was not feeling like I had a choice. If I was unmedicated still, I'm pretty confident I'd be dead by now. I've made my share of attempts, but almost all were when I was unmedicated, or on That One Really Bad Med. Given the choice between "kill myself now" and "try one more medication," trying one more thing generally seemed like "Fuck it, why not?"

Things that helped, or that I wish I'd done sooner:
  • Not even bothering getting psychiatric advice from a GP — going straight to a specialist when something was wrong.
  • Having a psychiatrist who was a really good listener. Actually, with one exception, I've had my best luck with psychiatric nurse practitioners, who for various reasons end up having more time to do face-to-face patient care and really pay close attention to what you're saying
  • Meeting with that psych regularly when things were bad — often once a month.
  • Listening to what my friends and partner said about whether I was doing better or worse.
  • Being loud and outspoken with my psych about what was working, what wasn't, and what I wanted to try. Ones who weren't OK with that weren't the right ones for me.
  • Being open about expressing complicated, maybe-irrational things like "This isn't working, I'm still super fucking suicidal, but it's helping some and so I'm scared to go off it" or "You're saying this med might help, and I agree in theory, but it's got a lot of stigma around it and that freaks me out."
  • Knowing other psych patients — both in my social circle and through support groups.
  • Knowing some psych patients who were doing worse than me. I had to resist the urge to think things like "I'm too good for this support group; I'm a respectable professional and some of these people can barely live independently." People who have been through bad shit can give you great advice on the bad shit.
  • Pursuing trauma treatment too. Finding a therapist who specialized in trauma. Treating "trauma or depression" as a false dichotomy — the answer can be "both," and for treatment-resistant folks it often is.

posted by nebulawindphone at 5:28 AM on June 24, 2019 [5 favorites]

1. If I were doing it over again, I would definitely try harder to keep a mood journal and chart my daily moods on a 1-10 scale. As it was, my side effects were so clearly and unambiguously bad, and so different from anything I'd experienced before, that I did not feel any doubt (although my prescribing nurse practitioner nudged me a little to push through the side effects - which feels weird in retrospect because there are SO MANY OTHER meds to try.)

2. I was not ever suicidal but I did feel that I was crawling out of my skin, that I could no longer tolerate being in my own body. I just held on to the fact that the med would eventually be out of my system. And I guess the process of being diagnosed and prescribed the antidepressant made me aware of what an intolerable place I was in, and gave me hope that things would be different, which - it was pretty disappointing when instead things got worse, but I did have it in my head that there might be SOMETHING out there that would help me.

3. I was quite worried that my side effects would worsen my professional reputation, (or my academic reputation, anyway) but I caught them quickly and no one said anything about them. I had one three-hour class where I was excrutiatingly self-conscious of my own movements but I got through it.

4. Jaw pain, akathisia [Akathisia is a movement disorder that makes it hard for you to stay still. It causes an urge to move that you can’t control. You might need to fidget all the time, walk in place, or cross and uncross your legs.] Akathisia is a super rare side effect of SSRIs - it's more common for antipsychotics - but when I read the definition on medical sites it was very much a "wtf, this is a real thing, there's a word for it" moment. The first SSRI I tried has a reputation for digestive difficulties, which I had - my NP urged me to push through those first few days and I did, and those side effects weren't nearly as bad as the akathisia.

5. I was getting my medical care from a nurse practitioner at a university medical clinic when I got my prescription, which is not the ideal situation. When my side effects got sharply worse I called the office to tell them I was discontinuing the meds, and I set up a new appointment.

6. My NP suggested that she could refer me to a psychiatric nurse who worked at the same clinic, or prescribe me a different med, and I asked to be referred to the psych nurse because I felt like I'd been treated a little dismissively during the whole ordeal and because I was worried that the "just try a new SSRI" strategy wouldn't work for me and I would need some more outside-the-box intervention. (Partly because my side effects were so atypical.) The psych nurse did just try a new SSRI with me, but I feel like she took my concerns seriously.

7. Started on an SSRI, ended up on an SSRI, with an atypical antidepressant (buproprion) as an add-on to help with executive function stuff.

8. WebMD, other random medical-google sites.

9. I was actually pretty anxious about other people knowing what I was going through! So I didn't talk to people about it, except a little bit to long-distance friends online.

10. I went cold turkey, was unmedicated until I could get a new med figured out, and then tapered on to the new med.

11. [Answered in 6]

12. If you get terrified that nothing will ever work, that's because you are depressed and catastrophizing!
posted by Jeanne at 6:13 AM on June 24, 2019 [1 favorite]

Oh boy. I have been on the med-go-round for 20+ years. I'm finally on a combo that's working. I've also been tapering off some of the meds. I was diagoised with Major Depression with Psychotic Features, PTSD, Panic Disorder and Generalized Anxiety Disorder (and at one time Borderline Personality Disorder by one less than helpful psychiatrist).

The first AD I ever took was Prozac. It gave me such bad insomnia, I became suicidal and was hospitalized for a few days. After that, Zoloft. It made me manic (although I'm on it now and it doesn't do that).

I tried countless other ADs. Most pooped out because the psychiatrist I was seeing insisted on monotherapy.

I did end up hospitalized in an inpatient state hospital for about 6 months after doing a useless residential program for 2 months.

I tried the atypical antipsychotics and they made me gain weight like crazy and I was on super high doses too.

I was able to go off meds for a couple years, but came back to them.

Over the last 6 years or so, I've had an excellent psychiatrist who I see once a month. She sees people for 30 minutes (unlike previous psychiatrist) so there is time for her to do a complete assessment of the past month. She changed things around. She started me on Haldol for auditory hallucinations because I refused the atypicals (see weight gain above). I got bad tremors with that but Cogentin helped with that. Although it gave me dry mouth, that and the Haldol were life changing. I had bariatric surgery, which helped my mood greatly. To do that, I had to transition from the extended release of Effexor and Wellbutrin to the standard kind. She really helped me do that. She also worked with my oncologist going to bat for me when I didn't want to do Taxol because it was rendered useless by Wellbutrin. For me, the extra hassle of having to get a Lupron shot every 3 months was worth it because the Wellbutrin was working so well for me.

I'm also on Trazodone for sleep. My psychiatrist tapered me down to 150mg from 300mg. She had me try to go to 100mg, but that didn't work for me. She's happy for me to stay at 150mg if it's making it possible to sleep and sleep well.

Over the past 18-24 months or so, I've been tapering off meds. I don't expect to ever get totally off them. I was able to slowly taper off the Haldol though it did take me 2 go arounds. The first time the hallucinations came back. Then the Effexor. Effexor gave me nausea out the wazoo, and I used Zofran to treat that. As the dose decreased the nausea go better and I was able to use Ginger to manage. It also gave me urinary hesitancy that I put up with because the good outweighed the bad. For me, again, it was worth it. I'm off the Effexor now and don't have the nausea associated with that (though the Iron supplement gives me minor nausea).

I'm currently tapering off Lamictal. It helped a lot. I didn't have any noticeable side effects, so I know I'm not some freak of nature that reacts badly to all psychiatric medications.

The meds kept me alive. Seriously. I too think I'd be dead without them. But it wasn't all the meds. I had the bariatric surgery and lost 270 pounds. That there was huge. I worked with a psychologist that specialized in childhood trauma. I've started tackling my social anxiety and have been going to MeetUps. A NAMI group was also very helpful. I was also able to go back to work. I'm only working part time right now (as a preschool teacher) but that's more because of the Fibromyalgia pain than the psychiatric stuff.

During my worst times, I tracked my moods daily. I don't remember what I site I used, but it had some kind of card display and maybe you picked between two cards. It was helpful, but, in retrospect, I wish I had used something better. I wanted to write a Python program to do that, but wasn't able to for various reasons.

It definitely was frustrating at times. Like me wanting to quit frustrating. But as I've said before, there is light at the end of the tunnel. Feel free to MeMail me. This is sort of scattered because it's early in the morning.
posted by kathrynm at 6:19 AM on June 24, 2019 [2 favorites]

Response by poster: I hope this isn't threadsitting - thank you so sincerely to every respondent so far (and that goes for everyone I linked to, poster and commenter, in those previouslies). I am en route now to an appointment with my dr. that will hopefully be step forward in finding the right meds for me. I really, really deep down just want an easy cure all in this moment- but I do feel more prepared already, knowing that it's appropriate to expect it to take time to figure out, and not to get too despondent if I walk away from this appointment with some question marks still. I am sure I will continue referencing this thread in coming weeks and months, so feel free to keep them coming.
posted by seemoorglass at 6:35 AM on June 24, 2019 [5 favorites]

I was depressed and anxious (and later diagnosed with both Major Depressive Disorder and PTSD). I avoided medications, but the symptoms finally got so bad that my normal coping mechanisms no longer worked (I tried to exercise, but started crying when tying my gym shoes and made it maybe two houses down on a walk before I had to sit down). I went to a psychiatrist and requested Lexapro, because it was just gone to generic at that time and was shown to have few side effects. One of the common side effects of SSRIs is increased anxiety for the first few weeks, so I think I may also have been given a short (i.e., no refill) prescription for Ativan to help during that time.

The Lexapro helped my depression but not really my anxiety. And it just helped the depression enough to clear the fog a bit, but not entirely, and it sometimes seemed like the generic's effects would change depending on the manufacturer. So I asked my psychiatrist for a change. (I think I was seeing him every two weeks or so if we started a new med and monthly if I was stable on my meds, and a therapist weekly.) He put me on Zoloft, thinking the more sedating effects would calm my anxiety. I did not have to cross-taper, just switched to the Zoloft.

Zoloft made me SO sleepy and groggy that I knew within a day or two that I couldn't continue it. I was yawning dramatically at clients, which is not good (I let them know I had just started a new medication and was having side effects). Because I wanted to make my case to my psychiatrist and also track things to make sure I wasn't imagining or exaggerating things in my own head, I found some sort of simple tracker online to record my levels of anxiety, depression, sleepiness, happiness, amount of sleep, and maybe some other stuff. At my next appointment with my psychiatrist (two weeks after the appointment where he prescribed it), I showed him my tracker and talked about the side effects I was experiencing. He switched me to Cymbalta, an SNRI. (I don't think I had to cross-taper, but I don't remember.)

The Cymbalta was so much better. The depression was much less, and the anxiety was moderately less. At my next psychiatry appointment, the doctor upped the dosage a little because he thought it would help with the anxiety; he said the slightly higher dosage would help with the norepinephrine, which he thought was contributing to the anxiety. And with the increased dose, the anxiety... just went away. It was truly the first time in my life that I could remember not having that constant background "What if, what if, what if..." panicky voice in my head.

I stayed on Cymbalta for years, through a really (REALLY) rough patch. Once the situational stressors stopped, I discontinued the Cymbalta. Being on it, however, made me realize what "normal" (or at least, non-depressed and non-anxious!) felt like, and so it's easier now for me to be able to tell when I'm sliding toward depression and anxiety again.

And in terms of Primary Care Provider vs. Psychiatrist -- My general rubric is that I trust the PCP with an initial prescription, and if it works, great! If it doesn't, I want to go to a specialist. So like I said, I'm not sure who prescribed the Lexapro for me, but when it wasn't working, I worked with a psychiatrist from that point on. (Though he also had a Psychiatric Nurse Practitioner in his clinic and sometimes I saw her for my monthly check-in.)
posted by lazuli at 9:40 AM on June 24, 2019 [1 favorite]

This: I think, more than anything, having someone that knows you and can judge how you are while you work on the meds is probably the most important thing you can do. You are stuck inside yourself. You are not objective. You need someone you can trust who really knows you, who can say, "You seem more tired," or "You seem like you have a shorter temper now," or whatever.

I have anxiety/depression. I have been on Imipramine, Wellbutrin, Zoloft, Prozac, and a variety of others. Zoloft lasted the longest, which is weird, because at a certain point I realized it wasn't helping. But that was because my husband kept harping on how tired I was all the time. And I was. I wanted to sleep a LOT. I also was starving in the night, which was weird, because that is a fun side effect of Zoloft - it will make you feel hungry. But I just kept taking it. Because maybe this is normal now? Add to that all the other variables I went through in a few years' time that can affect mental health - bad job experiences, family issues, losing a family member to cancer, financial worries, being laid off, etc etc - and it gets harder to figure out what the meds are actually helping/not helping. It wasn't until I saw a psychiatrist and had to fill out the form about things I was experiencing that I just started crying and realized things had NOT BEEN OK for a long time.

Now I have it right, I think. We shall see, as it is still fairly early days. I'm on Cymbalta.
posted by routergirl at 9:50 AM on June 24, 2019 [1 favorite]

I’m not sure if my experience is as useful to you as others’ because I have not been as consistently proactive. Over the course of six years, I’d occasionally muster the will to ask a doctor for a med. They’d give it to me, I’d take it for a few months and it wouldn’t work for me, and I’d taper off on my own. This last time, the drug I picked out (my 7th one) seems to be helping, so after a very slow and inefficient process, success!

I’m mentioning this just in case it’s easier for you to be less stressed about it if you remember that trying meds doesn’t need to be a concentrated period of hell. If something doesn’t work and you don’t have the energy to try something else, you can take a break while you get your life back in order. This means it might take longer to find a solution, but if you find it’s disrupting your life too much, you don’t have to power through it all in one go… you have an out.

3. In my case, side effects never caused significant issues for me. SSRIs make me not care about anything, but in more of a stoner way than an angsty way, so it wasn’t a lot more disruptive than my typical depressed not caring about much. Some made me crave alcohol but I was still able to avoid it (I don’t drink while trying out meds). I went through hell during trazadone withdrawal, but that was due to my doctor’s bad advice… double-check what they tell you with what you can find on the internet about best practices.

4. Because my side effects were minor, I stopped taking them when I didn’t see an improvement over baseline for a few months.

5. This varied, but I generally had little contact. (My ability to find good healthcare providers remains poor, unfortunately.)
posted by metasarah at 11:27 AM on June 24, 2019 [1 favorite]

1. If you were already in pretty bad shape [mentally/self-esteem wise/trusting in your own experience and validity] before trying medication - how did you have any idea how to trust whether your first few medication trial runs were helping or hurting?

It's hard. Basically, I was only able to trust that eventually I would find the right cocktail because I had no other option. Talk therapy and coping skills were simply not enough and bouncing from crisis to crisis was unsustainable.

4. What exact symptoms did you experience during the “incorrect med/dosage/class” phase that you had a hunch or were sure that it was wrong for you? How long did it take to know it?

The most common failure was that I would wait the amount of time the meds were supposed to take to work and nothing would happen and I would still feel depressed/suicidal/constant panic attacks. Lithium made me throw up, so that was pretty obvious. Seroquel made me feel like my brain was underwater and daily functioning was difficult, but I stuck with it anyway and it didn't help in the long run.

5. How often were you in touch with your licensed medical professional during the trial and error process?

I had monthly appointments, but due to the puking we basically discontinued the lithium right away and met sooner to come up with a new strategy.

6. How active or passive were you in the process of selecting the new, better medication with your licensed medical professional?

I was entirely passive beyond giving feedback about what I had tried previously.

7. Did you end up on an entirely different type/class of drug than the one you started on? Does that type of drug not even necessarily fit what is normally prescribed for your “official” diagnosis?

Yes, I started on SSRIs and wound up on Lamotrigine, which is an anti-convulsant. Using Lamotrigine to treat bipolar is a recognized treatment.

12. What advice do you have for past you, during that trial and error time?

I know it seems impossible when you are in crisis, but be patient. Rely on your support system. Keep going to therapy.
posted by zeusianfog at 12:08 PM on June 24, 2019 [1 favorite]

i took topamax for a few years for chronic daily migraine. it gave me paresthesia and and brain fog and hair loss. but the pain relief i got from that drug was worth those rather shitty side effects.

last summer i started a 6 month period of trying a bunch of depression/anxiety drugs to see what would help me now (i have been on a lot of drugs over the years). there was one i started that made me feel awful. i gave it a couple days, and decided i felt fucking awful and wasn't going to see if it evened out. i took one drug a different time and after one dose i had violent suicidal ideations. took no more of that.

the thing to remember is you have full control. yes you should work with your doctor and be a team, but if you know a drug is making you feel shitty, and you will know, stop it. and go back to your doctor to try something else.

after 6 months of new drugs and shitty side effects and tapering up and tapering down, i finally said enough. i needed a break from that roller coaster and decided i could deal with my depression/anxiety for a couple months to get back to an even keel.

you are in control.
posted by misanthropicsarah at 12:49 PM on June 24, 2019

This isn’t exactly the same but given your description, I think my experience fits. When I first started seeking treatment for a sleep disorder, friends of friends referred me to a sleep doctor. My husband had seen him and he was legit. This doctor was/is the best. The first time I saw him, he said something like, “you must be really tired.” Just having someone appreciate that was really comforting.

He gave me a prescription. My tiredness went away but I felt angry. I’m not an angry person so I recognized that was unusual. But the drug was working! I was so worried that was it - learn to deal with anger or go back to feeling exhausted all the time. I had a follow-up with the doctor maybe a month later and he asked how it was going. I told him and he’s like, okay, there’s a variation of that drug that’s basically the same, maybe that’ll work better. It did. I still take it.

Looking at your numbered questions, 1+2 don’t apply and I think I answered 4 (I noticed it within weeks). Re: 3, I think I hid my anger well at work.

5: I just reconnected with my doc at a regularly scheduled follow-up appointment.

6: passive - this class of drugs is pretty small and my doc is an expert so I trust him.

7: no.

8: this particular drug doesn’t require you to build up a tolerance. When I want it to work, I take it. So to test whether it was making me angry, after I got the new prescription, I tried the old drug one day and the anger came back.

9-11 don’t apply. 12: trust your doc and the process.

Hope that’s helpful. Best wishes!
posted by kat518 at 3:37 PM on June 24, 2019 [1 favorite]

I hope that your appointment went well.

People have already given better and more comprehensive answers than I can right now, but I wanted to add a little bit. You may have seen some of my answers in those previous questions you looked at. I'll try to come back and do a more formal answering sometime later.

Since 2001, I have tried around 20 psychiatric medications. Trying to remember and list them all, as I had to do recently for a new psychiatrist as the electronic records only go back to 2012 or 2010, is real fun. I am currently taking 4. I've been taking the same meds for several years now. There haven't been any really new psych meds in a while.

I have only had one potentially life threatening reaction. I developed a rash all over my abdomen while taking oxcarbazepine (Trileptal) after about 3 weeks. Large unexplainable rashes are bad.

Shortest trial was 4 days (Abilify, made me very hostile). I have had a few others that were so obviously problematic that I took them for less than a week. Most I tried for at least a month. Some I have taken or tried more than once.

Obviously a lot of them didn't work for me, or were not right for the long term. It took a long time. I experienced all kinds of side effects, some livable and some not. My current meds do have some side effects, but they are acceptable to me.

But the points that I wanted to make are: that even the ones that didn't work did do something, and you probably won't notice changes in yourself very well. So it is important to have someone who knows you and cares to give you feedback. It is also good to have a person who knows when you are starting or stopping meds, because they can be your safety net for catching bad reactions. And when I was in a state that resembles what you describe being in, any change was good, even if I felt worse. Because it meant that change was possible.

All of the therapy and meditation and thinking and lifestyle stuff in the world were not going to help me. They didn't help. Medication helped. It isn't magic, and it isn't perfect, but it is a tool.

Yes, a lot of it sucked and sometimes I was not the person I wanted to be. But even when it was not what I was hoping for, pretty much all of it was better than the unrelenting hopeless suffering I had been mired in before I started taking medication.

PS - RE: Suicidal thoughts.

When I first started medications I was scratching myself as a method of control, and I was miserable enough to want to die and say that out loud. My practitioner made me promise her and my mother not to go any further with self harm and that I would not try to kill myself without calling her first. She promised me that she would not force me to take any specific medication if I didn't want to take it after researching it, and she would not force me to continue taking anything that I found unacceptable, as long as I was willing to keep trying other medications.

Later, when I had some bad reactions to things and felt miserable to that point again, I had two cats that I had to take care of. I had made a commitment to them, and even if there is nothing after this life, I didn't want to be that person. I didn't want to disappoint my cats.

You have to find your own reasons, but they're there if you look. If you have trouble thinking of something, I'd be happy to help you brainstorm by memail.
posted by monopas at 7:35 PM on June 24, 2019 [2 favorites]

I had a prescription for an SSRI (Lexapro), and I stayed on it for 15 months. I started at 5mg a day to test for adverse side effects and then started taking 10mg/day. It worked extremely well, except I took frequent naps (on average spending ~11 more hours in bed per week), which I very gladly accepted. The months before I took Lexapro, I didn't feel in control of myself, but I also didn't question my perception of reality.

Because the SSRI worked so well for me, I wasn't sure if I was interested in trying other medication, but over time I stabilized, and I also hit a period where it wasn't feasible for me to sleep as much anymore. During a session, I talked to my therapist about this and they agreed that I should consider trying other medications if I felt I was stable. My psychiatrist then prescribed me Wellbutrin. I cross-tapered and started at 100mg, and then increased to 200mg and then 300mg. I realized Wellbutrin wasn't as effective as Lexapro for me ~3 weeks in, but I decided to stick it out because I didn't have any side effects. When I was only taking 200mg/day, I was quite weepy (which did not impact my quality of life but was strange), and I mentioned this to my psychiatrist, who prescribed the extended-release (XL) version of Wellbutrin while upping the dosage to 300mg.

I was on the normal Wellbutrin for about 2 months, and then on the XL for about 5 weeks. I noticed on the regular Wellbutrin at 200mg/day I was easily annoyed, which was very unusual for me and something that was easy for me to spot. It was concerning but I was insistent on trying the medication for longer.

On the XL at 300mg/day, I started having anger issues and increased sensitivity a few weeks in. At one point during a (large) meeting I had to quietly leave the room because there were so many people and everyone was talking at once, which was overwhelming to me both as a sensory and professional/emotional/personal experience (specifically, having anxiety about the way I was perceived and having to mediate conflicts and potentially getting in the cross-fire). I also got extremely angry at any perceived unfairness, sometimes fearing I would become violent. I wasn't generally in a state of anger, and it was unpredictable whether I would become angry at some slight. At this point I also started questioning my perception of reality. I couldn't really tell if my version of events was quite true or warped by my anger. It was clear, though, that my emotions were disproportionate (e.g., having road rage). The work thing happened one week and then I had two incidences in the span of a few days the next week when I almost lost control of myself.

This prompted me to go back to 200mg/day of the regular Wellbutrin. About 2-3 weeks back in, I realized Wellbutrin was even less helpful than I thought. It was hard to get out of bed as well as initiate conversations with my coworkers, and I also had bouts of extreme tiredness. Although Wellbutrin didn't affect the number/intensity of the suicidal thoughts I had, I previously talked with my therapist about signs that another depressive episode was coming (and these were it), so I was able to identify it somewhat quickly. There was also a built-in app on my phone which tracks phone usage, and to see the numbers increasing was clarifying. And, like JZig, having a journal was helpful in understanding how I felt on different medications. The way I journaled while I was on Lexapro is pretty distinct from when I'm on Wellbutrin. It solidified the fact that Wellbutrin truly wasn't doing much; before reading my entries I had some doubt-- like, perhaps coincidentally worse things were happening in my life which could account for the low moods... but no. I'm now back on Lexapro.

I see my psychiatrist monthly and my therapist weekly. I was with my therapist before I started changing medications, and they checked in about mood changes week-to-week, and also prompted me to contact my psychiatrist when they thought that there was anything unusual (e.g., weepiness). It was helpful since I tended to brush things off as unimportant. I also checked in with a friend when I experiencing episodes of intense anger, and she was grounding.

I feel like I had some control over dosage although I was not active in selecting different medications with my psychiatrist. She asked if I wanted to increase the Lexapro dosage in the beginning, and I said no. After my experience with Wellbutrin XL, she asked how I wanted to change my medication (e.g., lower dosage/switch release mechanism/go back to Lexapro) and we did that.
posted by typify at 12:58 AM on June 25, 2019 [1 favorite]

Response by poster: Hi everyone, thanks again for all the good info and good wishes. One more update:

a) I did get to my appointment finally and did finally get the meds (both of those processes were like a 3 stooges display of absurd obstacles... two vehicles didnt see me walking on the way to my appointment and nearly hit me, I missed my train by a minute, then after my appt my prescription was held up in various pharmacies across the city until I finally picked them up, all the way back at my drs office, 5 hours after my initial appointment)
b) I'm now on day 2 of celexa (taking it in the morning to avoid any worse insomnia than I already have) and have ativan as needed which I've been taking before bed to get a small reprieve from racing thoughts and drop off to sleep
c) the lows in my anxious-depression cycle have seemingly gotten even lower the last two days (but they are punctuated by a couple neutrals and highs since then too, I'm still here!)
d) as such I am going to a PHP (partial hospitalization program) near me tomorrow. (I tried for McLane but 6-8 wk waiting list). I'll have 2 days of that program this week, 8:30-5:30, then a break on the weekend (and a family member will stay with me during that time) then more of the PHP program for I don't know how long.

For right now at least, just glad to be here and thanks again for the support. TY TY TY
posted by seemoorglass at 6:35 AM on June 26, 2019 [4 favorites]

Response by poster: Update time:

Life is still really hard. I get triggered by a lot of stuff. I kind of can’t be alone a lot. But I’m hanging in there with less and less SI as I focus on self soothing environments and strategies.

The partial program is AMAZING. It has structure, really helpful coping strategies sessions spaced neatly throughout the day, excellent enforced rules about patients NOT sharing their specific traumas that could be triggering to others, it’s very open to different self-soothing techniques (essential oils, drawing, etc) and I found one that is women’s only and it is perfect for my situation. I can go home and have just enough normalcy each day that I can still live my life, and be focusing on intense treatment too.

Regarding my post topic, medication - I’m still in the “wait and see” phase of celexa. Honestly it doesn’t feel like it’s really helping but I kind of have to tough it out over 6 weeks before we can try something else. And who knows, maybe it will work! (None of my fears about side effects have come true, it’s honestly fine - some minor flatulence and wooziness the first nights but nothing beyond that).

What I wanted to particularly share about is that I finally finally seem to have a diagnosis that makes sense. While I still have PTSD and symptoms from that, I also have “Agitated depression” which I had never heard of before. In a nutshell and my own words, it’s like having bipolar, but just at one pole. So rather than swinging between manic highs at one end and depressive lows at the other (bipolar), you swing between “normalcy” (for lack of better word) at one end, and extremely keyed up agitation that coincides with severe depressive thoughts, at the other end. Wow, bingo. Das me.

I just wanted to share this for posterity, because I know I am not my illness, BUT having a proper diagnosis that does describe my symptoms feels like a small small little victory. It feels like less hopeless that I’m not getting magically better on celexa. It gives me forum topics to delve into, and knowledge that I could be proactive and offer for example a tricyclic medication to my psychiatrist, if celexa never really does kick in properly. I feel more equipped to start wrapping my head around the fact that I’m going to be fighting this fight longer than just a few weeks. And that is starting just barely to feel doable. I’m getting more comfortable asking for help too, and being honest when things are bad.

So in case anyone who really needs to read this is doing so, hang in there! The rays of hope might come in weird forms but they’re there.
posted by seemoorglass at 5:25 AM on July 11, 2019 [3 favorites]

Response by poster: hello again. it me, the poster child for medication and partial hospitalization programs.

life is pretty good again. not all the time, not even most of the time, but the needle of my worldview has gone from negative to juuuuust barely positive. I wouldn't be surprised if the celexa has finally kicked in, and I'm also on mood stabilizer (abilify) and beta-blocker (propranolol) and sleeping support (hydroxazine) and damn is life better now.

Honestly I feel that Abilify made the biggest and most immediate medication difference - maybe it's placebo, but I almost instantly felt more centered, grounded, and less extreme swings of despair (the pendulum was often swinging between "I'm fine, everything is OK, I am just a melodramatic insipid drama queen who cannot handle small life hurdles, this is all fine I just have to pull my bootstraps up a little higher" and utter and complete despair with intrusive SI. That cycle seems to be done, at least for now! I AM SO HAPPY ABOUT THAT!

The partial program continues to be really helpful. I'm almost done with it and am so so so grateful programs like it exist in the world. It wasn't always perfect, by any means (hello, high school lunchroom dynamics! hello, part time clinicians who are not clear on the group guidelines! hello, armed police presence every week or so!) BUT it really did provide the structure, support, guidance, and routine that I needed when I really, really needed it.

I'm going to head back to work in the next few weeks. I am very nervous about it but I will survive. I really feel I've gotten a lot of good skills from the DBT groups and I have already workshopped some conversations I will have. I also feel more confident in returning to work and having it be OK to not know if it's going to be the best decision for me long term or not. I don't have to decide right now! what a concept!

I still don't know or care that much about an exact diagnosis. I suspect that borderline fits most of my symptoms, but I am subscribing to the school of thought where as long as I'm on the right meds, who cares, a diagnosis is just for insurance purposes.

Thanks again everyone who has helped along the way, and more power to anyone who reads this is in the future - it is in fact totally possible to go from extreme despair to feeling OK. I really did not believe it at times but I am living (!) proof of it. It does not happen overnight, and I know I still have a long road of uncomfortable therapy sessions ahead of me, but holy crap am I in a better spot now than I was a few months ago.
posted by seemoorglass at 2:46 PM on August 3, 2019 [7 favorites]

Response by poster: hi again. I'm doing pretty well, and wanted to update after a month back at work. The routine of work (in addition to therapy and meds) has been immensely helpful and as scary as it was to think about going back, I strongly believe that getting back into a productive routine has been a big reason why I am doing so remarkably better.

I got my diagnosis (finally) and I'm still adjusting to it, it's a lot to process but I'm doing OK with it. The paranoia has all but disappeared. I no longer have intrusive SI thoughts since I've been back at work. I did gain 20 lbs since the stat of the summer likely due to the abilify negating the sensation of ever being truly full (in addition to spending a solid 3-ish months with a very sedate routine from mid-May to mid-August). I do grind and clench my teeth on the Citalopram too but it's manageable with a mouthguard. I'm not thrilled with both these side effects but honestly I'd rather be fat and relatively content, than thin and literally psychotic.

I still have ups and downs, and a lot of stuff still to work through (most of it is in the 'setting and sticking to boundaries' category). I still am erring on the side of caution when it comes to extending myself energetically - I've pulled way back on social engagements, how many commitments I say yes to, how late I stay out, etc. and it seems to be working great for the most part. I mostly just tend to my plants, work on my class assignments and some art projects, and try to make food I like eating. Everything else is just a bonus really. Sometimes it's a little lonely to be so much more quiet schedule-wise, but it's actually less lonely than running around being booked to the gills and frantically trying to fill time to not be alone with my thoughts.

Very happy to be sending such a positive update. I am at the point where I look back on how I was doing in May and June and just feel so sad and sorry for that version of me. I am so proud of myself for getting the help I needed and not giving in to the darkest timeline thoughts I was having. I am so happy for this major life reset I am taking on and I am so grateful for all the people who helped during that time including many mefites. I hope anyone who reads this knows there is good in the world even when it is REALLY really extremely hard to find. sending love!
posted by seemoorglass at 2:09 PM on September 23, 2019 [1 favorite]

Yay!!!! SOOOO great to be following your updates! I'm thrilled to read that you're doing so well and have stayed on your meds. It is absolutely a marathon and not a sprint.

My daughter is still getting her meds tweaked over a year later (it's going to be a lifelong thing for her) but she is an entirely different person. She, too, gained a bunch of weight. A lot of it is from being sedentary, but also from making poor food choices. One of her meds tends to make her hungry all.the.time. We're working on this and are planning on trying something to address it in the somewhat near future. Boundaries are also a thing (because they tend to lead to frustration), but it's a learning curve. Are you able to still attend outpatient groups now that you are working?

Congrats on doing all the hard work to get yourself here - because it really IS hard work. You're doing an awesome job. And thank you for your continued updates! Big, big warm hugs. :)

My daughter, thankfully, is attending a therapeutic school that is just outstanding. She has a therapist, along with a psychiatrist within the school, and they have groups/processing daily. The regular routine of school seems to make a significant difference in her coping abilities (on the occasion there is a school break, the change in her behavior/personality is dramatic).
posted by dancinglamb at 12:20 AM on September 24, 2019 [1 favorite]

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